Provider Demographics
NPI:1275654337
Name:WOOLFOLK, CASSANDRA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:B
Last Name:WOOLFOLK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W WHITE ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3112
Mailing Address - Country:US
Mailing Address - Phone:217-359-3809
Mailing Address - Fax:
Practice Address - Street 1:1315 CURT DR STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-1168
Practice Address - Country:US
Practice Address - Phone:217-359-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0040911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical